Miranda L Perrero, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149023062 Issued in IL

Practice address

1008 Timber Dr
Mahomet, IL 61853-3523

Phone

(309) 337-1318

NPI assigned

Apr 20, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miranda Shryack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1427545847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 TIMBER DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618533523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 TIMBER DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618533523",
            "telephone_number": "309-337-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRERO",
        "first_name": "MIRANDA",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-20",
        "last_updated": "2023-04-26",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149023062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "SHRYACK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lorena Oliver, ATC, LAT
• Moulikatou Olouchessi
• Onachukwu G Osaji, M.D.
• Krista Overstreet
• Michael J. Palazzolo, M.D.
• Jeffery Eugene Pietrzak
• Paige Pintar, LSW
• Megan Kathleen Ramirez, PMHNP-BC
• Daniel Ray, PHARMD
• Martin J Repetto, MD

• Clinical Social Worker in Mahomet, IL
• Providers in Mahomet, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.